Seven steps to reducing surgery complications
When the Joint Commission on Accreditation of Healthcare Organization distributed a Sentinel Event Alert on operative and postoperative complications, the agency also listed several risk-reduction strategies that can prevent such complications. Here are the strategies that relate to the outpatient surgery setting, along with advice from same-day surgery managers on how to apply these in your facility:
• Improving staff orientation and training.
Have orientation and training guidelines with a list of items to cover so that important aspects of the process aren’t omitted, suggests Vicki Sullivan, RN, CNOR, administrative director of Quad City Ambulatory Surgery Center in Moline, IL. However, be flexible because staff differ in their previous training and in their ability to absorb new information, she says. Mentors also are critical, Sullivan says. "They can pass on so much of the culture that your center has developed, so new people know what is expected of them and how they approach outpatient surgery differently, and they have the feeling they are responsible and accountable for their work."
Orientation should include education on how to handle high-risk events, says Susan Kizirian, MBA, executive director of Southeastern Surgery Center in Tallahassee, FL. Not only does her center review high-risk events at orientation, they are covered annually with all staff members, she says. Additionally, staff bring up safety issues at weekly meetings, she says. "That can’t be overdone."
• Educating and counseling physicians.
Physicians don’t always know the routine standards procedures as well as the staff, Sullivan says. "So sometimes you have to educate physicians by saying, This is the way we do it in our center. This is what works for us.’"
• Standardizing procedures across settings of care.
Hospitals and their affiliated surgery centers should standardize their procedures, same-day surgery experts agree. "The more they can standardize, particularly if you’re sharing personnel, the more they can be accurate in your assessment and care," Kizirian says. This standardization is especially critical when "once-in-a-blue-moon" adverse events happen, she emphasizes. "Otherwise, you put someone in the situation of asking, What do I do now?’"
Nonaffiliated freestanding centers and hospitals programs should standardize within their individual programs, says Ann Geier, RN, MS, CNOR, chief operating officer of Medicus Surgery Center in Anderson, SC. For example, "If you perform IV conscious sedation in your OR and in GI lab, are you operating with the same standards of care? You should be," she says.
• Revising credentialing and privileging procedures.
These issues are critical for managers to review, just as orientation and training should be reviewed, Kizirian says. "Because the information that we have is constantly being expanded, because technology is constantly changing, privileges and credentialing need to be updated."
• Clearly defining expected channels of communication.
Train your staff so they are comfortable knowing how the communication process works in your program, Kizirian emphasizes. "Caregivers have to know who to communicate what to at what point in the process," she says. For example, who do they talk to when they need to question an inappropriate order?
• Revising the competency evaluation process.
"Because information and technology are changing, the skill levels we have have to change," she says. "We have to revise evaluations as the way we provide service changes."
Same-day surgery centers often are challenged in this area because they don’t have large staff development departments or nurse specialists in staff development, Geier says. "We have to develop our own competency evaluations." Medicus managers collaborate with hospital same-day surgery nurses, she says. "We do a yearly competency process, and every year I wish it could be better."
Quad City handles competencies through required inservices on topics such as infection control and malignant hypothermia, Sullivan says.
• Monitoring consistency of compliance with procedures.
Same-day surgery programs have an advantage when it comes to ensuring staff are complying with procedures, Sullivan says. "When you’re in a smaller environment, you know if someone’s not doing as they’re expected. Everyone is visible, it’s all open," she says. "Communication is so direct, and feedback from patients is so direct — usually within the next day. So if someone hasn’t followed the customary standard, you soon become alerted to that."
Ensure that staff don’t fall back and follow previous procedures after the procedures are changed, advises Mark Mayo, facility director of Valley Ambulatory Surgery Center in St. Charles, IL.
"Nurse managers need to observe, note what they see, make necessary changes, and then follow through to make sure positive changes are made and carried through weeks or months later," he says.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content